The proposed framework for whole of health system performance information and reporting

Please scroll down to view the preliminary recommendations and findings for this section of the review.

Have your say

To have your say on this section of the review, please click here to answer the following questions:

  1. What are your views on the proposed framework for health system performance and reporting, including the recommendations on what should be included in the framework? Is there anything missing from the proposed framework? (Please limit response to 400 words or less)
  2. What are your views on the recommended principles for indicator selection?* (Please limit response to 400 words or less)
    * The review has recommended principles for the selection of indicators. A review of the indicators themselves was not in the scope of this review.
Recommendation 1
The NHPF and PAF should be combined to create one overarching health system performance information and reporting framework.

Rationale for Recommendation 1

The review has found that the overarching logic of the NHPF is sound and is consistent with international best practice. The NHPF and PAF in combination provide an important focus on performance at multiple layers of the health system and have over time increased accountability of jurisdictions and service providers.

Combining the NHPF and PAF into one framework would deliver a number of benefits. It would create a single source of truth that provides a more thorough picture of Australia’s health system performance, and allow for information gaps to be identified and addressed in a coordinated manner. It would also reduce resourcing costs and administrative burden by streamlining processes and roles in health system reporting.

There is an opportunity to ensure that the new combined framework is aligned to other relevant performance information and reporting frameworks, including RoGS, the Aboriginal and Torres Strait Islander Health Performance Framework and relevant health frameworks in each jurisdiction. These frameworks should be linked and subordinate to the overarching framework, with coordination and oversight provided by NHIPPC and NHISSC.


Recommendation 2
The optimal health system performance information and reporting framework should:
  • be based on the logic of the NHPF
  • be linked to strategic priorities
  • consist of a defined purpose, audience and beneficiaries
  • expand coverage of equity to become a lens across the whole framework
  • be driven by the principle of transparency
  • include analysis of consumer experience and satisfaction of the healthcare system
  • ensure the needs of different populations are considered
  • include both technical and allocative efficiency
  • allow for sub-jurisdictional analysis of regional areas.

The proposed health system performance information and reporting framework

A proposed framework for whole-of-health system performance information and reporting is provided below. It is based on the NHPF, with adjustments to reflect the recommendations of the review. The items circled in red are additional elements to the framework that have been recommended in this review and are not currently captured in the NHPF or PAF.

Proposed health system performance information and reporting framework

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Rational for Recommendation 2

The review has found that combining the NHPF and PAF will streamline the cost of data collection and provide a stronger linkage to health system priorities.

The framework should…

Be based on the logic of the NHPF The review has found that the NHPF is based on international best practice and its logic is sound. Therefore the proposed combined framework should be based on the structure and domains of the NHPF.
The PAF should be incorporated into the NHPF as appropriate. NHPA’s review of the PAF indicators consolidates the views of the sector on performance indicators. The recommendations within this review should be considered when combining the framework’s indicators.
Be linked to strategic priorities The framework should align with the strategic priorities of the health system. It should reflect the contemporary strategic context and the latest knowledge in health system performance information and reporting.
The framework and indicators should be regularly monitored and periodically evaluated to ensure they are linked to strategic priorities and remain relevant and effective.
Consist of a defined purpose, audience and beneficiaries

An optimal performance information and reporting framework should serve a number of purposes, on the principle of minimising unnecessary workload and maximising return to information providers. It must be aligned with the needs of its audiences and beneficiaries.

However, the review has found that the purposes of the current frameworks are unclear and overlap. In addition, the specific audience and beneficiaries of the frameworks are undefined.

The proposed framework should include an overarching purpose and clearly define its audiences and beneficiaries, providing a catalyst for system drivers of improvement.

Have equity as a lens across the whole framework

The review has found that the focus on equity in current frameworks is too narrow. Equity is not explicitly identified in the NHPF, although the framework does include the question “Is it the same for everyone?” at all points. Equity is explicitly captured in the PAF and RoGS, but only in the context of accessibility. This focus overlooks other important measures such as appropriateness of care, the provision of additional services to correct health disadvantage and the pursuit of equitable health outcomes.

Equity is a vital measure to determine the performance of Australia’s health system. It should be included in the proposed framework as an element in its own right spanning the whole framework, including determinants of health, health system performance and health outcomes.

Be driven by the principle of transparency Transparency should be a key organising principle for the development and implementation of the framework. It not only underpins the purpose of health system performance, but also acts as a guiding principle for operationalising the framework. In an age of open data, there is a growing expectation for more information and transparency around health services. The principle of transparency should be a lens across the framework. It should drive action and cooperation in the health system and underpin actions of organisations that support health system performance and information reporting.
Include analysis of consumer experience and satisfaction of the healthcare system

Patients’ experience of healthcare and their satisfaction with services are not sufficiently captured in the current frameworks. The NHPA did use patient experience data from the ABS Health Survey to make small-area comparisons in some of their reports, such as the Healthy Community Reports, and commenced work to expand reporting on the patient experience. However, the PAF, NHPF and other reporting frameworks do not provide for a comprehensive analysis of the patient experience.

‘Consumer experience’ should be added to the proposed framework’s responsiveness domain measuring health system performance. This is to ensure that indicators underpinning this domain include client perspectives of service experience. Consideration should also be given to incorporating consumer perspectives into all or most domains of health system performance.

Ensure the needs of different populations are considered

The health system must be responsive to the needs of population groups with specific health concerns and vulnerabilities. This includes older people, culturally and linguistically diverse (CALD) communities, Aboriginal and Torres Strait Islander communities, people with chronic conditions and people with mental health conditions.

The accessibility domain of the proposed framework should account for the need to ensure the framework is inclusive of and responds to the differing needs of all population groups in Australia.

Include both technical and allocative efficiency

Technical efficiency indicates that inputs in the health system are effectively used to produce positive health outcomes. Allocative efficiency indicates the resources are effectively allocated based on consumer preferences and the needs of the Australian population. Both are critical for an effective and sustainable health system.

The review has found that current frameworks do not clearly articulate the need for both technical and allocative efficiency. The proposed framework should specify that indicators on efficiency cover both technical and allocative efficiency. This will ensure that both are adequately captured and incentivised through health system performance measurement.

Allow for sub-jurisdictional analysis of regional areas

The PAF currently supports useful sub-state analysis. This enables more accurate comparisons between and within jurisdictions, allowing for a better understanding of relative performance across the health care system. It also allows analysis of different population groups.

The proposed performance framework should account for the sub-jurisdictional analysis conducted through the PAF of Local Hospital Network, Primary Health Networks, hospitals, by Statistical Area Level 3 and by postcodes. The framework is able to be applied at a sub-jurisdictional level.


Recommendation 3
The indicators supporting the combined framework should:
  • include a mix of process and outcome indicators
  • balance coverage across primary health care and hospital systems (both public and private)
  • be structured in tiers tailored to the level of the health system they are reporting on
  • provide for a deliberate cross-cutting focus of key populations, such as culturally and linguistically diverse (CALD) communities, people with chronic conditions, people with mental health conditions, Aboriginal and Torres Strait Islanders and older people.

Rational for Recommendation 3

While this review has not focused on the combined framework’s underlying indicators, the review recommends four key principles to determine their development.

The indicators should…

Include a mix of process and outcome indicators

There is currently a lack of outcome indicators in the NHPF and the PAF. Many of the current indicators focus on throughput or output rather than measuring the change or improvement of patient’s experience or clinical outcome. This does not provide insight to the effectiveness of the health system at either a patient or population level.

The use of outcome indicators is important to ensure understanding of the treatments and practices that are most effective, which ultimately leads to improved patient outcomes and to improved health for the population as a whole. There should be a balance between outcome and process indicators in a new framework.

Balance coverage across primary health care and hospital systems (both public and private)

Current frameworks have only limited measurement of both primary care and non-public health care providers (private hospitals and health care and community managed organisations). This creates a gap in the understanding of continuity of care across the healthcare system. NHPA’s MyHealthyCommunities provided some reporting on primary care, but this can be further progressed.

The proposed framework should include the activities of GP and specialist services, allied health services, pharmaceutical services, along with promotion and health intervention initiatives. It should also include indicators to map the patient journey through the entire health system, including public and private providers.

Be structured in tiers tailored to the level of the health system they are reporting on

There are some indicators in the PAF and NHPF that are applied to the whole system, without adequate consideration of their relevance to different levels of the health system.

Indicators can be tiered so that they are applicable to each level of the health system. This ensures the right information reaches the appropriate decision makers who can positively inform future performance. The proposed framework should adopt a similar system of indicator tiers for each level of the health system.

Provide for a deliberate cross-cutting focus of key populations, such as culturally and linguistically diverse (CALD) communities, people with chronic conditions, people with mental health conditions, Aboriginal and Torres Strait Islanders and older people.

Stakeholders underlined the importance of measuring the health needs and experiences of key populations, as well as the responsiveness of the system to the specific needs of these populations. This is critical from an equity perspective. It is also important for managing the additional pressures on the health system from conditions that disproportionally affect certain populations.

Indicator measurement should capture the specific health conditions and health status of key populations. It should also capture the performance of the system in terms of responding to key populations.

Have your say

To have your say on this section of the review, please click here to answer the following questions:

  1. What are your views on the proposed framework for health system performance and reporting, including the recommendations on what should be included in the framework? Is there anything missing from the proposed framework? (Please limit response to 400 words or less)
  2. What are your views on the recommended principles for indicator selection?* (Please limit response to 400 words or less)
    * The review has recommended principles for the selection of indicators. A review of the indicators themselves was not in the scope of this review.